EP21.09: The SAFER technique for fetoscopic open spina bifida repair in twin pregnancies: moving towards a new recommendation for prenatal treatment

Résumé fourni par la source

To report the outcomes of 7 twin pairs, in which at least one of them had open spina bifida (OSB) and was prenatally repaired by the SAFER technique in Brazil. Seven patients self-referred to our centre for OSB prenatal repair. After extensive ethical discussion to consider surgery, later GA surgery was agreed as attempt to balance the best interest of the affected fetus and the harm threshold for the unaffected one. Parents were aware that it was a new procedure, as multiple pregnancies are an exclusion criterion for prenatal repair. All cases had 2 scans: at referral and before surgery. Motor level (ML) was assessed and compared to postnatal neurological evaluation. Postnatal data was obtained by NICU discharge report. Six DCDA and two MCDA co-twins underwent fetal surgery. All were successfully repaired. No maternal complications occurred during surgery. GA of surgery and delivery were 28.3 (27.7-29.8) and 32.4 (31.6-33.9) weeks. Duration of surgery was 150 (132-151) min. Trocar numbers ranged from 3 (62.5%) to 4 (37.5%) for each sac. Four cases had PPROM with an interval of 3.9 (3-4.5) weeks from surgery. Deliveries were by Caesarean section. Birthweight was 1611 (1413-1693) and 1965 (1790-2160) grams in affected and unaffected cases (p = .04). No significant change in ML was found in both prenatal evaluation (p = 0.857). Out of 7 cases, 2 had similar and 4 had improved postnatal ML compared to prenatal ML. No neonatal deaths occurred. NICU hospitalisation ranged from 49 (27-62) and 23 (19-29) days for the affected and unaffected twin (p = .05). No sepsis or sequela of prematurity was found in the unaffected twin. No baby needed revision of the repair or had CSF leak. Prenatal repair of OSB in twins is feasible and appears to be safe to the unaffected twin development when performed by highly experimented team. Delaying GA of surgery improves protection of the co-twin and complications related to extreme prematurity. Larger cohorts are needed for assess risks and benefits, especially for the unaffected twin.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.